HSJ Weekly Catch Up: CareBnB, slow motion pathology, and zero days analysis

CareBnB back for another try

The company developing a controversial “Airbnb for social care” model allowing homeowners to rent spare rooms to recuperating hospital patients is bidding to launch a new trial in Cambridge.

This time it’s hoping to work with local government. It has begun advertising for “host” households in the county.

The CareRooms model will most likely live or die on whether it can create a robust enough safeguarding and governance model and - equally importantly - convince its critics that it is indeed as safe as the company claims it is.

The horror story of course would be the death of a frail, older person (or anyone for that matter) left languishing and neglected in the spare room of a chancer with no care experience seduced by the prospect of a nice little earner.

The company insists its vetting and safeguarding systems, 24/7 biometric monitoring, and a range of CQC-regulated services would prevent that.

CareRooms says it won’t be regulated by the CQC because neither the company nor the hosts are providing care (they are effectively a bed and meals service). However, any care provision within the rooms will be carried by CQC-regulated services.

The idea that such a service could be launched without the CQC oversight feels intuitively wrong.

Slow-motion pathology shake-up

Pathology consolidation has been tried many times before, with varying degrees of success, but a national attempt to deliver £200m savings got underway last September.

Progress on NHSI’s plans to create 29 pathology networks between acute non-specialist trusts has been mixed so far, HSJ analysis has found. Of the 29 areas proposed, less than half have agreed to NHSI’s plans.

But the majority of remaining networks are either forming alternative plans or awaiting decisions from individual trusts, and only five of 29 networks suggested by NHSI are trusts yet to confirm any kind of plan.

Reasons for trusts disagreeing with NHSI’s plans differ across the country, but include existing arrangements with other trusts, plans put in place prior to NHSI’s project, and concerns over distances between trusts, IT connectivity, and workforce implications.

NHSI is currently reviewing the responses from trusts, and will publish “updated networks” at a later date.

A new dawn for troubled Wirral?

The chair of troubled Wirral University Teaching Hospital resigned this week, following the exposure by HSJ of a series of governance and cultural problems at the trust.

Michael Carr – whose departure has been welcomed by NHS Improvement – was the subject of serious allegations by trust executives alongside former chief executive David Allison. Remarkably, several executive board directors had felt it necessary to take their serious concerns about their own organisation to NHSI.

Earlier this month a non-executive director resigned, saying there had been a complete breakdown of relationships at board level.

HSJ understands that Mr Carr will receive no additional money and stepped down following conversations with senior figures at NHSI. The regulator imposed new chair David Henshaw using its powers in a sign of how bad the situation is among executives and non-executives.

Ian Dalton, chief executive of NHSI, said: “Michael Carr’s departure is the right thing for patients and the right thing for staff. This is a trust that has had a number of serious leadership, governance and cultural problems which need to be urgently addressed.”

Zero to hero

Two thirds of the growth in emergency admissions in recent years has been for patients who are discharged without an overnight stay, HSJ analysis has revealed. 

The rising proportion of “zero day” admissions is currently the subject of discussion at the highest levels of national bodies, which are trying to determine how many of the admissions are necessary and whether providers are being paid appropriately for them.

HSJ bureau chief David Williams has examined the issue. He writes: ”The vital question that NHS Improvement and NHS England need to be able to answer is: should zero day admissions be rising as fast as they are?

“No one believes that all zero day admissions are unnecessary, but opinion is split on whether all of the growth is justified.

“Optimists argue that short stay emergency admissions are being driven by ever more appropriate and more efficient forms of care: that people who otherwise would have been kept in overnight unnecessarily are leaving after a few hours. Thanks to trusts’ investment in ambulatory urgent care, the argument goes, ward capacity is kept free for the patients that really need it, while those patients who just need a few tests or a bit of observation get to go home sooner.

“That argument is most commonly heard from providers, and emergency care leaders.

“The counter, which comes more from the commissioner side, questions whether all those admissions are appropriate, and whether trusts might be being overpaid for some of them. For example, not all zero day admissions are alike: a patient discharged in under two hours probably needed less treatment than someone who was kept in for eight hours. Commissioners may sensibly ask whether all those two hour admissions were really necessary at all. The average tariff rate is £600 per emergency admission. Is that too much for those ultra short stays?”

Carillion carrion latest

Outsourcing giant Serco is moving closer to snapping up contracts for facilities management services at five acute NHS trusts.

Having initially agreed a £47m deal with Carillion for the contracts last autumn (when Carillion was fighting a losing battle to stay in business), Serco last week announced it had signed a “business purchase agreement” with PwC over 15 public sector contracts.

These 15 include five contracts for FM services at Cambridge, North Bristol, Dartford and Gravesham, South Tees, and Great Western hospital trusts.

The value of those five contracts, which are tied up in PFI deals, is not clear.

However, the deal is not done yet as the five trusts and their PFI partners also have a say in the matter, and it is these parties Serco is currently negotiating with. Expect more news on this in the next few weeks.

It is not clear how many contracts the company is eyeing, but HSJ understands the portfolio includes services for which Carillion was incurring financial penalties due to consistent poor performance.